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Penn State equation versus indirect calorimetry for nutritional assessment in patients with traumatic brain injury

Sonia Wu, Sameena Iqbal, Melanie Giroux, Norine Alam, Josie Campisi, Tarek Razek, Dan Deckelbaum, Jeremy Grushka, Katherine McKendy, Evan Wong, Judith Marcoux and Kosar A. Khwaja
CAN J SURG May 11, 2022 65 (3) E320-E325; DOI: https://doi.org/10.1503/cjs.022420
Sonia Wu
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi)
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Sameena Iqbal
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi)
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Melanie Giroux
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi)
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Norine Alam
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi)
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Josie Campisi
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi)
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Tarek Razek
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi)
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Dan Deckelbaum
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi)
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Jeremy Grushka
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi)
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Katherine McKendy
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi)
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Evan Wong
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi)
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Judith Marcoux
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi)
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Kosar A. Khwaja
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi)
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    Fig. 1

    Proportion of required calories received by patients with traumatic brain injury (TBI) on day 1 of their intensive care unit (ICU) stay and throughout their ICU stay, overall and by severity.

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    Table 1

    Demographic and clinical characteristics of patients with traumatic brain injury, overall and by severity

    CharacteristicGroup; no. (%) of patients*p value
    All
    n = 23
    Moderate
    n = 6
    Severe
    n = 17
    Age, median (range), yr42 (18–87)72 (42–87)38 (18–83)0.03
    Age group, yr
     18–4513 (56)2 (33)11 (65)0.2
     46–652 (9)0 (0)2 (12)
     > 658 (35)4 (67)4 (24)
    Male sex16 (70)3 (50)13 (76)0.09
    Hypertension6 (26)2 (33)4 (24)0.6
    Alcohol/substance use5 (22)1 (17)4 (24)0.7
    Diabetes mellitus4 (17)1 (17)3 (18)1.0
    Coronary artery disease2 (9)2 (33)0 (0)0.01
    Dyslipidemia3 (13)2 (33)1 (6)0.09
    Hyperthyroidism/hypothyroidism4 (17)2 (33)2 (12)0.2
    Injury Severity Score, median (range)17.0 (1–75)11.5 (1–57)20.0 (4–75)0.2
    Multiple trauma16 (70)4 (67)12 (71)0.9
    Glasgow Coma Scale score, median (range)7 (3–10)10 (9–10)6 (3–8) < 0.001
    Height, median (range), m1.77 (1.52–1.97)1.62 (1.52–1.83)1.78 (1.58–1.97)0.02
    Actual weight, median (range), kg74 (52–105)68 (52–98)74 (58–105)0.6
    Ideal weight, median (range), kg67.6 (53.1–82.4)60.0 (53.1–73.7)70.4 (56.1–82.4)0.04
    First-day caloric intake, median (range), kcal196.0 (0.0–881.7)443.0 (0.0–881.7)196.0 (60.5–417.0)0.3
    Penn State equation estimate, median (range), kcal1680 (960–2330)1430 (960–1800)1726 (1180–2330)0.08
    Caloric intake during ICU stay, median (range), kcal1073 (828–1493)1025 (983–1349)1116 (828–1493)0.2
    First-day indirect calorimetry reading, median (range), kcal1776 (971–2750)1344 (971–2189)1865 (1167–2750)0.2
    Indirect calorimetry reading, median (range), kcal1833 (1090–2631)
    n = 12
    1488 (1090–2264)
    n = 3
    1865 (1167–2631)
    n = 9
    0.2
    • ICU = intensive care unit.

    • ↵* Except where noted otherwise.

    • View popup
    Table 2

    Spearman correlation coefficients for comparison between the Penn State equation estimate and indirect calorimetry readings

    Comparison; groupCorrelation coefficientp value
    Penn State equation v. mean indirect calorimetry
     Overall0.4570.03
     Moderate TBI0.9290.002
     Severe TBI0.1740.5
    Penn State equation v. first-day indirect calorimetry
     Overall0.4830.02
     Moderate TBI0.9290.002
     Severe TBI0.2320.4
    • TBI = traumatic brain injury.

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Canadian Journal of Surgery: 65 (3)
CAN J SURG
Vol. 65, Issue 3
25 May 2022
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Penn State equation versus indirect calorimetry for nutritional assessment in patients with traumatic brain injury
Sonia Wu, Sameena Iqbal, Melanie Giroux, Norine Alam, Josie Campisi, Tarek Razek, Dan Deckelbaum, Jeremy Grushka, Katherine McKendy, Evan Wong, Judith Marcoux, Kosar A. Khwaja
CAN J SURG May 2022, 65 (3) E320-E325; DOI: 10.1503/cjs.022420

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Penn State equation versus indirect calorimetry for nutritional assessment in patients with traumatic brain injury
Sonia Wu, Sameena Iqbal, Melanie Giroux, Norine Alam, Josie Campisi, Tarek Razek, Dan Deckelbaum, Jeremy Grushka, Katherine McKendy, Evan Wong, Judith Marcoux, Kosar A. Khwaja
CAN J SURG May 2022, 65 (3) E320-E325; DOI: 10.1503/cjs.022420
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